Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215690 DEA: 074W9504 EFIS: 0720000200
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91-R12.1/R20.7
Work Description: INDIVIDUAL SLAB REPLACEMENT.
Location Description: LOS ANGELES COUNTY IN LONG BEACH AND CERRITOS FROM ATLANTIC AVENUE UNDERCROSSING TO THE ORANGE COUNTY LINE
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Thang Ton Structure Rep.: Unknown
DIME Sample ID: 2021-11-06-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Santa Fe Springs Field Laboratory
Sample Organization Contact: (562) 345-3148
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 11/06/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/06/2021
The quantity of what the sample constitutes: 130 CY
A brief description of the sample: pcc beams rsc
From where was the sample collected: Job Site
Laboratory sample identification: 21-2709
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Short Load Concrete
The concrete mix design number: CTS-65-EHI
The truck number from where the sample was collected: load 3
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: NA
The fabricator/manufacturer designation for the sample: NA
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: Individual Slab Replacement
From Lot No.: NA
Bag Lot No.: NA
DIME Test ID: 2021-11-06-7-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D07 - Santa Fe Springs Field Laboratory
Organization Address: 13230 Firestone Boulevard, Suite J,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: arnold.truong@dot.ca.gov
Organization Phone: (213) 808-4582
Data has not been verified.
DIME Test ID: 2021-11-06-7-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D07 - Santa Fe Springs Field Laboratory
Organization Address: 13230 Firestone Boulevard, Suite J,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: arnold.truong@dot.ca.gov
Organization Phone: (213) 808-4582
Data has not been verified.
